Alassane Diouf

Traitement chirurgical des kystes clitoridiens compliquant des mutilations génitales féminines

We report the surgical management of eight vulvar tumors occurred at the waning of female genital mutilation practiced in childhood. Patients were aged 19 to 38 years. It was essentially excision type 2. Surgical excision of the labia minora with a refund without clitoral plasty gave satisfactory aesthetic and functional results. Histological examination of these tumors showed a single cyst containing keratin without inflammatory reaction.

Premiers résultats de la cœlioscopie gynécologique au Centre hospitalier universitaire (CHU) de Dakar : série prospective de 128 cas

OBJECTIVES To analyze the results of, and to evaluate, gynaecologic laparoscopy in Dakar Teaching Hospital. METHODS This exploratory and descriptive study deals with a continuous series of 128 gynaecologic laparoscopies carried out between January 1, 2006, and December 31, 2009. In each operative case, sociodemographic and clinical parameters,operative data, and outcomes were studied. RESULTS Laparoscopies represented 14.37% of the programmed operative activities. The average age of the patients was 32 years,and the average parity was 1.2. The interventions were most frequently undertaken because of infertility (78.9%). A history of pelvic infections was found in 39.8% of the cases. The most frequent pathologies were tubal anomalies (70% of infertility cases) followed by ovarian cysts (10.1%) and endometriosis. The operative interventions included adhesiolysis in 35.1% of cases,and tubal surgery in 30.4%. A conversion, necessary in 7% of cases, was necessitated by the extent of adhesions (3 cases),the treatment of an associated pathology (4 cases), or a technical difficulty (2 cases).The main complications were vascular wounds and uterine perforations. The average operating times for diagnostic and operative laparoscopies were 56 minutes and 107 minutes,respectively. Outcomes were simple in 91.8% of cases. During the immediate postoperative period, a death occurred due to an acute pneumopathy. The average length of hospital stay was 3 days. We observed a pregnancy rate of 4.6%. Assisted reproduction was indicated in 28.7% of infertility cases. CONCLUSION Given its many advantages, diagnostic and operative laparoscopy must be integrated and developed by gynaecology departments in developing countries. This necessity is emphasized by the prevalence of tubal infertility of infectious origins, which, if diagnosed and treated early by laparoscopy,could have a better prognosis.

Dispositif intra-utérin mis en place en cours de césarienne. Étude pilote réalisée au centre hospitalier universitaire de Dakar

OBJECTIVES To demonstrate the feasibility of copper IUD insertion following cesarean deliveries and assess its safety. PATIENTS AND METHODS This is a prospective pilot study at Pikine national hospital from February 15 to November 15, 2012. Were evaluated the efficacy, incidence and spectrum of complications and continuation rates. RESULTS Fifty-nine subjects were enrolled and 46 received an IUD. The average age of patients was 28 years. No patient had previously used IUDs. Forty-four patients (97.5%) were returned to the first follow-up visit at the first month, 41 patients (89.1%) at the second visit and 39 patients (86.9%) at the third visit. The rate of lost sight was 8.7%. Pain and bleeding were reported rarely: 2.3% at the first month, 4.9% at the third month and 7.7% at the sixth month for the bleeding and 6.8% at the first month, 2.4% at the third month and 2% at the sixth month for pain. The rate of expulsion was 2.2%. CONCLUSION The insertion of the IUD following cesarean delivery has an acceptable rate of expulsion and no increased rate of adverse effects. This technique should be popularized.

Assessment of Five Years of Endoscopic Activity in a Maternity Hospital in the Suburbs of Dakar

Introduction: The practice of minimally invasive surgery in Senegal occupies more and more of a preponderant place in fields that previously did not allow it. Thus in our practice in gynecology we are witnessing an explosion of these operative indications especially for benign adnexal pathology. Patients and Method: The objective of this study was to evaluate the evolution of laparoscopic practice in terms of frequency, indication of duration and operative complications. For this reason, we have collected all the laparoscopic procedures carried out at the Gynecology and Obstetrics Department of the Pikine National Hospital since January 1st, 2012 over a period of 60 months. Endoscopic surgery accounted for 20.1% of all gynecological and breast procedures. There were 195 cases (14.9%) of laparoscopic surgery and 69 cases (5.2%) of operative hysteroscopy. The average age of our patients was 34 years with extremes of 15 and 67 years. The intervention was motivated by the exploration or management of infertility in 101 cases, or 57.1% of patients. Laparoscopy remained exploratory in 15.3% of cases (279 patients) with 55 cases of ovarian tumors presumed to be benign. The mean duration of diagnostic laparoscopy was 39 min with extremes of 20 to 150 min; while that of operative laparoscopy was 59 min with extremes of 20 to 250 min. It was noted that 4 cases of laparoconversion are 2.8% of all patients in our series. The postoperative course was 99.4% simple. Conclusion: In our practice and as in the developed countries, we are witnessing a considerable decline in the indications of laparotomy to the profile of laparoscopy, especially for benign adnexal pathology and infertility. An extension to the gynecological malignant pathology is the ultimate challenge.

Assessment of the side effects of progestogen only contraception in the immediate postpartum period: the case of implants with levonorgestrel Jadelle®

Background: The aim of this study was to evaluate the side effects of Jadelle® implants in the immediate postpartum. Methods: To do this, we inserted the implants at two different postpartum period: first, between the first and the seventh day for the immediate postpartum period (IPP) group; second, between the 45th and the 3rd postpartum months for the late postpartum (LPP) group. The variables studied were age, gesture, parity, abortions, number of live children, childbirth, caesarean section, quality of milky climb, age last child, pregnancy-attendant, pregnancy term at time of delivery, complaints, weight. Results: From May 2012 to December 2013, we collected two hundred patients, one hundred from each group (immediate postpartum and late postpartum). The average age of mothers in the IPP group was 28 years and 29 years for LPP group. After insertion, in both group, spotting were the most frequent complaints. The weight variations were between +800 g and -600 g for the group IPP and +260 g and -170 g for the other group; which makes a statistically significant difference. In both groups, at the end of the six months, no patient had menstruation. Conclusions: Our results are encouraging to further promote contraception in the immediate postpartum period in developing countries and thus reach a wide range of users. We can therefore say that the side effects are not different during this period and largely are also tolerated.

Problématique de la prise en charge des cancers du sein au Sénégal: une approche transversale

L’heure où les thérapeutiques innovantes se multiplient dans le cancer du sein, des pays moins nantis comme le Sénégal accusent encore un retard considérable dans la prise en charge globale de ce type de cancer. Au Sénégal, même si la prise en charge des cancers du sein avancés est actuellement bien codifiée, les résultats en terme de survie et de morbidités sont encore médiocres vu les retards diagnostiques et les traitements mutilants, parfois onéreux et mal tolérés, devenus nécessaires. Pour ces cancers avancés, les défis qui restent à relever résident dans l’érection de centres de soins palliatifs et le développement de la pluridisciplinarité pour améliorer la qualité de vie et l’accompagnement des malades. En revanche, pour les cancers infracliniques ou potentiellement guérissables, les défis restent immenses car il s’agira de les dépister, de bien les localiser et les diagnostiquer aussitôt (biopsie écho guidée ou stéréotaxique) mais également de les opérer de façon précise et entière (repérage – exérèse in sano et radiographie de pièce opératoire) tout en limitant les complications comme celles du curage classique (biopsie du ganglion sentinelle). Il s’agit là autant d’objectifs auxquels nos structures de santé ne sont pas toujours préparées. Cette mise au point est une analyse situationnelle sur les écueils contextuels qui grèvent encore la prise en charge globale des cancers du sein au Sénégal.At a time when innovative therapies in breast cancer multiply, poorer countries such as Senegal are still lag far behind in the overall management of this type of cancer. In Senegal, although the treatment of advanced breast cancer is now well codified, survival and morbidity outcomes are still mediocre in view of diagnostic delays and of sometimes expensive and poorly tolerated mutilating treatments become necessary. With respect to advanced cancers, the challenges will lie in building of palliative care centres and in developing multidisciplinary approaches to improve quality of life and to support patients. On the other hand, with respect to preclinical or potentially curable cancers, the challenges are immense given the importance of early detection, localisation and diagnosis (stereotactic or ultrasound guided biopsy) but also of precision surgery and of complete resection (indexing - excision ensuring a margin of healthy tissue and specimen radiograph) while minimizing complications such as those of classic dissection (sentinel lymph node biopsy). Our health structures are not always prepared to achieve these goals. This is a situational analysis of the contextual obstacles that still exist and add a burden on the overall management of breast cancer in Senegal.